What Should You Know About Menopause And Dementia Risk

Approximately 6 million people 65 and older in the United States have Alzheimer’s [1]. The fact that women make up nearly two-thirds of them has long been a source of puzzlement for scientists, who have long linked the difference to factors like heredity and longer life expectancies [2]. However, there is increasing agreement that menopause may also be a significant risk factor for dementia later in life.

Women who enter the life phase—clinically described as the point at which fertility ends—experience numerous changes in their brains in addition to their ovaries. The majority of women adapt to these changes without experiencing long-term health problems, but in the decades that follow, 20% of them will develop dementia [3].

Is There any Link Between Menopause and Dementia

The areas of the female brain that regulate mood, memory, sleep, and body temperature are especially abundant in estrogen receptors, and these areas function optimally when levels of estrogen are stable and high. Estrogen is also essential for the brain’s ability to protect itself from aging and damage [4].

The distinctive reduction in estrogen during menopause impacts the functioning of specific brain regions and is believed to change the brain structure. Scans reveal decreased brain volume in menopausal women compared to the brains of men of the same age and pre-menopausal women [5].

These brain changes may be the cause of some menopausal symptoms, such as hot flashes, mood swings, and a mild, generally transitory loss in memory and cognition.

They also bear similarities to pre-dementia brain alterations. Although the exact relationship between the two is unclear, several brain regions affected by menopause are also affected by Alzheimer’s.

Research has also linked menopause symptoms, including insomnia and hot flashes, to dementia. A study published in 2022 discovered that hot flashes were associated with an increase in the number of tiny lesions in the brain, which are a sign of declining brain health, according to Dr. Pauline Maki, a professor of psychiatry and director of the Women’s Mental Health Research Program at the University of Illinois at Chicago and co-author of the study [6]. A more recent study found that hot flashes during sleep were linked to a rise in blood-based biomarkers for Alzheimer’s disease, which act as early warning signs of the condition [7].

Although the findings of this research may seem concerning, most women’s brains and cognitive abilities stabilize after menopause.

Beyond that, there are other actions you may take to support your well-being and mental capacity despite decreasing estrogen.

How can you protect your brain?

According to experts, three factors, in particular, are likely to have the most significant effect on women going through menopause since they address both the immediate symptoms and the long-term risk of dementia.

1. Hormone Therapy on Time

For many years, scientists were worried that hormone therapy for menopausal symptoms would raise an older woman’s risk of dementia. However, more recent research looks more thoroughly at the therapy’s timing and paints a more complex picture. According to one such study that examined the results of over 50 studies, hormone therapy initiated around the time menopausal symptoms appeared was connected with a lower incidence of Alzheimer’s disease and dementia [8].

Other studies have revealed that hormone therapy does not affect dementia or Alzheimer’s risk but is successful at treating hot flashes and night sweats while also increasing quality of life, all of which are critical predictors of brain health [9][10].

2. Regular Exercise

Women are more likely than men to develop neurodegenerative disorders as a result of physical inactivity [11].

A 2018 study that tracked over 200 middle-aged women for 44 years discovered that the higher their fitness level at the beginning of the study, the lower their risk of acquiring dementia later in life [12]. Middle-aged women who were physically active showed fewer signs of Alzheimer’s disease in their brain scans than their inactive peers.

3. Healthy Diet

Recent studies have revealed a link between a lower incidence of dementia in both men and women with specific diets, such as the Mediterranean diet and the MIND diet, which focus on fruits, vegetables, whole grains, lean proteins, and healthy fats.

These plant-rich diets may also offer some additional advantages to women. According to a preliminary study, eating a diet high in plants can support specific gut bacteria that may help balance the body’s estrogen levels [13].

References

1. Alzheimer’s Disease Facts and Figures. Alzheimer’s Association. https://www.alz.org/alzheimers-dementia/facts-figures. Accessed: 11th January, 2024.
2. Rajan, K.B., Weuve, J., Barnes, L.L., McAninch, E.A., Wilson, R.S. and Evans, D.A., 2021. Population estimate of people with clinical Alzheimer’s disease and mild cognitive impairment in the United States (2020–2060). Alzheimer’s & dementia, 17(12), pp.1966-1975.
3. Chêne, G., Beiser, A., Au, R., Preis, S.R., Wolf, P.A., Dufouil, C. and Seshadri, S., 2015. Gender and incidence of dementia in the Framingham Heart Study from mid-adult life. Alzheimer’s & Dementia, 11(3), pp.310-320.
4. Spence, R.D., Hamby, M.E., Umeda, E., Itoh, N., Du, S., Wisdom, A.J., Cao, Y., Bondar, G., Lam, J., Ao, Y. and Sandoval, F., 2011. Neuroprotection mediated through estrogen receptor-α in astrocytes. Proceedings of the National Academy of Sciences, 108(21), pp.8867-8872.
5. Than, S., Moran, C., Beare, R., Vincent, A.J., Collyer, T.A., Wang, W., Callisaya, M.L., Thomson, R., Phan, T.G., Fornito, A. and Srikanth, V.K., 2021. Interactions between age, sex, menopause, and brain structure at midlife: a UK Biobank study. The Journal of Clinical Endocrinology & Metabolism, 106(2), pp.410-420.
6. Thurston, R.C., Wu, M., Chang, Y.F., Aizenstein, H.J., Derby, C.A., Barinas-Mitchell, E.A. and Maki, P., 2023. Menopausal vasomotor symptoms and white matter hyperintensities in midlife women. Neurology, 100(2), pp.e133-e141.
7. Thurston, R.C., Maki, P., Chang, Y., Wu, M., Aizenstein, H.J., Derby, C.A. and Karikari, T.K., 2023. Menopausal vasomotor symptoms and plasma Alzheimer disease biomarkers. American Journal of Obstetrics and Gynecology.
8. Nerattini, M., Jett, S., Andy, C., Carlton, C., Zarate, C., Boneu, C., Battista, M., Pahlajani, S., Loeb-Zeitlin, S., Havryulik, Y. and Williams, S., 2023. Systematic review and meta-analysis of the effects of menopause hormone therapy on risk of Alzheimer’s disease and dementia. Frontiers in Aging Neuroscience, 15, p.1260427.
9. Henderson, V.W., St. John, J.A., Hodis, H.N., McCleary, C.A., Stanczyk, F.Z., Shoupe, D., Kono, N., Dustin, L., Allayee, H. and Mack, W.J., 2016. Cognitive effects of estradiol after menopause: a randomized trial of the timing hypothesis. Neurology, 87(7), pp.699-708.
10. Faubion, S.S., Crandall, C.J., Davis, L., El Khoudary, S.R., Hodis, H.N., Lobo, R.A., Maki, P.M., Manson, J.E., Pinkerton, J.V., Santoro, N.F. and Shifren, J.L., 2022. The 2022 hormone therapy position statement of the North American Menopause Society. Menopause, 29(7), pp.767-794.
11. Nianogo, R.A., Rosenwohl-Mack, A., Yaffe, K., Carrasco, A., Hoffmann, C.M. and Barnes, D.E., 2022. Risk factors associated with Alzheimer disease and related dementias by sex and race and ethnicity in the US. JAMA neurology, 79(6), pp.584-591.
12. Hörder, H., Johansson, L., Guo, X., Grimby, G., Kern, S., Östling, S. and Skoog, I., 2018. Midlife cardiovascular fitness and dementia: a 44-year longitudinal population study in women. Neurology, 90(15), pp.e1298-e1305.
13. Baker, J.M., Al-Nakkash, L. and Herbst-Kralovetz, M.M., 2017. Estrogen–gut microbiome axis: Physiological and clinical implications. Maturitas, 103, pp.45-53.
14. Gupta, A.H., How Menopause Changes the Brain. The New York Times. https://www.nytimes.com/2023/11/21/well/mind/menopause-dementia-risk-estrogen.html. Published Online: 21st November, 2023. Accessed: 11th January, 2024.